Healthy Skepticism Library item: 1443

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Publication type: news

Kluger J.
Medicating Young Minds: Drugs have become increasingly popular for treating kids with mood and behavior problems. But how will that affect them in the long run?
The Times Online 2003 Oct 26

Full text:

EXCERPT:

Getting by is hard enough in middle school. it’s harder still when you’ve got other things on your mind-and Andrea Okeson, 13, had plenty to distract her. There were the constant stomach pains to consider; there was the nervousness, the distractibility, the overwhelming need to be alone. And, of course, there was the business of repeatedly checking the locks on the doors. All these things grew, inexplicably, to consume Andrea, until by the time she was through with the eighth grade, she seemed pretty much through with everything else too. “Andrea,” said a teacher to her one day, “you look like death.”

The problem, though neither Andrea nor her teacher knew it, was that her adolescent brain was being tossed by the neurochemical storms of generalized anxiety, obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD)-a decidedly lousy trifecta.

If that was what eighth grade was, ninth was unimaginable.

But that was then. Andrea, now 18, is a freshman at the College of St. Catherine in St. Paul, Minn., enjoying her friends and her studies and looking forward to a career in fashion merchandising, all thanks to a bit of chemical stabilizing provided by a pair of pills: Lexapro, an antidepressant, and Adderall, a relatively new anti-ADHD drug. “I feel excited about things,” Andrea says. “I feel like I got me back.”

So a little medicine fixed what ailed a child. Good news all around, right?

Well, yes-and no. Lexapro is the perfect answer for anxiety all right, provided you’re willing to overlook the fact that it does its work by artificially manipulating the very chemicals responsible for feeling and thought. Adderall is the perfect answer for ADHD, provided you overlook the fact that it’s a stimulant like Dexedrine. Oh, yes, you also have to overlook the fact that the Adderall has left Andrea with such side effects as weight loss and sleeplessness, and both drugs are being poured into a young brain that has years to go before it’s finally fully formed. Still, says Andrea, “I’m just glad there were things that could be done.”

Those things-whether Lexapro or Ritalin or Prozac or something else-are being done for more and more American children. In fact, they are being done with such frequency that some people have justifiably begun to ask, Are we raising Generation Rx?

Just a few years ago, psychologists couldn’t say with certainty that kids were even capable of suffering from depression the same way adults do. Now, according to PhRMA, a pharmaceutical trade group, up to 10% of all American kids may suffer from some mental illness. Perhaps twice that many have exhibited some symptoms of depression.

Up to a million others may suffer from the alternately depressive and manic mood swings of bipolar disorder (BPD), one more condition that was thought until recently to be an affliction of adults alone. ADHD rates are exploding too. According to a Mayo Clinic study, children between 5 and 19 have at least a 7.5% chance of being found to have ADHD, which amounts to nearly 5 million kids. Other children are receiving diagnoses and medication for obsessive-compulsive disorder, social-anxiety disorder, post-traumatic stress disorder (PTSD), pathological impulsiveness, sleeplessness, phobias and more.

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“The world would be a far less interesting place if all the eccentric kids were medicated toward some golden mean. Besides, there are just too many unanswered questions about giving mind drugs to kids to feel comfortable with ever broadening usage. What worries some doctors is that if you medicate a child’s developing brain, you may be burning the village to save it. What does any kind of psychopharmacological meddling do, not just to brain chemistry but also to the acquisition of emotional skills-when, for example, antianxiety drugs are prescribed for a child who has not yet acquired the experience of managing stress without the meds? And what about side effects, from weight gain to jitteriness to flattened personality-all the things you don’t want in the social crucible of grade school and, worse, high school.

Adding to the worries is a growing body of knowledge showing just how incompletely formed a child’s brain truly is. “We now know from imaging studies that frontal lobes, which are vital to executive functions like managing feelings and thought, don’t fully mature until age 30,” says Hinshaw. That’s a lot of time for drugs to muck around with cerebral clay.

For that reason, it may not always be worth pulling the pharmacological rip cord, particularly when symptoms are relatively mild. Child psychologists point out that often nonpharmaceutical treatments can reduce or eliminate the need for drugs. Anxiety disorders such as phobias can respond well to behavioral therapy-in which patients are gently exposed to graduated levels of the very things they fear until the brain habituates to the escalating risk.

Depression too may respond to new, streamlined therapy techniques, especially cognitive therapy-a treatment aimed at helping patients reframe their view of the world so that setbacks and losses are put in less catastrophic perspective. “The therapist teaches relaxation skills and positive thinking,” says Denise Chavira, clinical psychologist at the University of California at San Diego. “It goes beyond talk therapy.”

Unfortunately, medical insurance pays more readily for pills than these other treatments for adults and children.”